Pyridostigmine 3-[[(Dimethylamino)-carbonyl]oxy]-1-methylpyridinium (Mestinon.TM.), and Neostigmine 3-[[(Dimethylamino)-carbonyl]oxyl]-N,N, N-trimethylbenzeaminium (synstigmin), and Edrophonium N-Ethyl-3hydroxy-N, N-dimethylbenzenaminium are all cholinergic agents. These compounds have several known uses including treatment of mysasthenia gravis, esophageal chest pain, and pre-exposure antidote to chemical warfare nerve agents. These compounds may also be useful in treating carpel tunnel syndrome.
Pyridostigmine and neostigmine are generally administered to a patient as a bromide salt, while Edrophonium is generally administered as a chloride salt. While these known monovalent salts are generally considered to be adequate, it is now contemplated that multivalent salts would potentially be more stable, and may have better physical characteristics, especially in solid physical dosage form. There may also be advantageous pharmokinetics over the monovalent salts. Still fturther it is contemplated that compounds having multiple quaternary ammonium sites may have usefll pharmaceutical benefits.